PHYSICIANS AND SURGEONS' WORKSAFEBC SERVICES AGREEMENT - April 1, 2019 - March 31, 2022 - Doctors of BC
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PHYSICIANS AND SURGEONS’
WORKSAFEBC SERVICES AGREEMENT
April 1, 2019 – March 31, 2022
The Workers’ Compensation Board of British ColumbiaTable of Contents
CONTRACT ............................................................................................................... 1
1.0 Definitions and Interpretation ............................................................... 2
2.0 Services ............................................................................................. 4
3.0 Term of Agreement .............................................................................. 4
4.0 Relationship Between Doctors of BC and WorkSafeBC............................... 4
5.0 Liaison Committee ............................................................................... 6
6.0 Electronic Payment System ................................................................... 9
7.0 Invoicing ............................................................................................ 9
8.0 Payment ............................................................................................. 9
9.0 Physician Expectations ....................................................................... 11
10.0 Right of Set Off ................................................................................. 12
11.0 Dispute Resolution Between the Physician and WorkSafeBC .................... 12
12.0 Dispute Resolution Between Doctors of BC and WorkSafeBC ................... 12
13.0 Non-Waiver....................................................................................... 13
14.0 Variation of Agreement....................................................................... 13
15.0 General Contract Notices .................................................................... 13
16.0 Force Majeure ................................................................................... 14
17.0 Miscellaneous .................................................................................... 14
18.0 Entire Agreement............................................................................... 14
SCHEDULE A - Description of Services ....................................................................... 16
1.0 Introduction ...................................................................................... 16
2.0 Physicians Role in Facilitating a Return to Work ..................................... 16
3.0 Occupational Health Education ............................................................ 17
4.0 Documentation Required to Initiate and Manage a Claim ........................ 17
5.0 Electronic Service Requirements .......................................................... 186.0 Medical Treatment - Forms, Reports And Services.................................. 18
7.0 Expedited Comprehensive Consultation ................................................ 19
8.0 Return To Work Consultation (Fee Code 19950) .................................... 20
9.0 Disallowed / Suspended Cases ............................................................ 21
10.0 Activities And Limitations Form............................................................ 21
SCHEDULE B - WorkSafeBC Unique Fee for Service Items ............................................ 22
1.0 Form Fees......................................................................................... 22
2.0 Physician Services Fees ...................................................................... 30
3.0 Expedited Consultation Fees by Specialists and Physicians with Areas of
Expertise .......................................................................................... 39
SCHEDULE C - Services Provided to WorkSafeBC on a Sessional and Expedited Basis ...... 42
1.0 Sessional Services ............................................................................. 42
2.0 Medical Advisors ................................................................................ 43
3.0 Expedited Services............................................................................. 43
SCHEDULE D - Fee Schedule for Sessional and Expedited Services................................ 48
1.0 Expedited Sessional Services............................................................... 48
2.0 Expedited Surgical Procedure Rates and Out of Office Hours Surcharge. ... 49
3.0 Expedited Anaesthesia Rates For Expedited Surgical Procedures .............. 52
4.0 Expedited Surgical Assist Rates For Expedited Surgical Procedures .......... 53
5.0 Expedited Psychiatry Services – Personal Services Agreement ................. 55
6.0 Medical Advisors ................................................................................ 60
SCHEDULE E - Disability Management Education Program Subcommittee ....................... 61
SCHEDULE F - Additional Commitments ..................................................................... 63
I. Additional Payment to Injured Worker’s Regular Physician ...................... 63
Ii. Timeline For Expedited Surgery and EMR Improvements......................... 63
Iii. Process Improvements ....................................................................... 65CONTRACT #H002020
PHYSICIANS AND SURGEONS’ WORKSAFEBC SERVICES AGREEMENT made effective
February 1, 2021 (the “Effective Date”)
BETWEEN:
ASSOCIATION OF DOCTORS OF BC
115 – 1665 West Broadway
Vancouver, BC V6J 5A4
(“Doctors of BC”)
AND:
WORKERS' COMPENSATION BOARD, doing business as WorkSafeBC
6951 Westminster Highway
Richmond, BC V7C 1C6
(“WorkSafeBC”)
1BACKGROUND:
A. WorkSafeBC is responsible for the administration of the Workers Compensation Act
RSBC 2019 c. 1 (the “WCA”) and has a mandate to provide health care and
rehabilitation services to workers who sustain injuries arising out of and in the course
of their employment;
B. In the exercise of its authority WorkSafeBC has established a series of programs and
services with different criteria and mandates that are designed to meet injured
worker and referral source needs, and to assist injured workers with recovery from
injury with a primary focus on returning to work in a safe and timely manner.
C. The Doctors of BC and WorkSafeBC wish to develop a working relationship to
facilitate the return to work for Injured Workers suffering from work related injuries.
D. Doctors of BC and WorkSafeBC entered into this Agreement with the intention of
negotiating a new agreement that sets out the terms and conditions under which the
Physicians shall provide Services to WorkSafeBC.
AGREEMENT
NOW THEREFORE, in consideration of the premises and mutual covenants contained herein,
Doctors of BC and WorkSafeBC agree as follows:
1.0 DEFINITIONS AND INTERPRETATION
1.1 DEFINITIONS The following terms shall have the following meanings when used in
this Agreement (the “Agreement”).
(a) “Agreement” means this Agreement and its schedules and the Physician
Reference Guide, appended thereto;
(b) “Board Officer” means a WorkSafeBC Case Manager, Client Service
Representative, Client Service Manager, WorkSafeBC salaried Medical Advisor,
Recovery and Return to Work Specialist or other as designated by WorkSafeBC;
(c) “business day” means any day, other than Saturday, Sunday, any statutory
holiday in the province of British Columbia and any other day on which
WorkSafeBC’s head office is closed to the public;
(d) “Consult” or “Consultation(s)” means meaningful seeking advice and
exchange of views prior to the making of a decision or the finalization of a policy
initiative, as the context may require;
(e) “Duration of Surgery” means the time from when the patient enters the
operating room to the time the patient leaves the operating room.
(f) “Electronically” means electronically transmitted by Teleplan or other agreed
to electronic transmission system;
(g) “Expedited” means Services required in a time sensitive and particular manner
by WorkSafeBC. This includes, but is not limited to, investigations,
consultations, surgery, anesthesia and all associated reporting;
2(h) “Extensive Spine Surgery” means difficult and extensive spinal procedures
requiring stabilization or multilevel procedures or revisions discectomy;
(i) “Health Care Services Program Manager” means A WorkSafeBC manager
in Health Care Services;
(j) “Injured Worker” means a person who has been determined to be entitled to
compensation under the WCA and who receives Services under this Agreement;
(k) “Liaison Committee” means the committee established under section 4.0 of
this Agreement;
(l) “Medical Advisor” means a Physician individually contracted by WorkSafeBC
to provide a variety of medical services in the claims management process as
determined by WorkSafeBC;
(m) “Physician” means a medical practitioner who is a member in good standing
with the College of Physicians and Surgeons of British Columbia;
(n) “Physician Reference Guide” means an administrative guide developed by
WorkSafeBC clarifying service requirements, reporting, and invoicing to assist
Physicians in understanding the Agreement between the Doctors of BC and
WorkSafeBC. The guide clarifies service requirements, reporting, and invoicing,
and does not provide medical guidelines;
(o) “Physicians with Areas of Expertise” means a non-Specialist Physician with
expertise in a specific branch of medicine or treatment
(p) “Services” means the clinical consultation, treatment, surgeries, anaesthesia
and reporting providing by the Physicians as set out by WorkSafeBC and agreed
to by Doctors of BC under this Agreement as specified in Schedules A to D of
this Agreement;
(q) “Sessional Services” means contractual arrangements with Physicians for the
provision of Services. Compensation for the Sessional Services shall be in
accordance to the specifications, qualifications and fees for the Services as set
out in Schedule C and D;
(r) “Specialist” means a Physician who is a certificant or fellow of the Royal
College of Physicians and Surgeons of Canada;
(s) “Visiting Specialist Clinic” or “VSC” means WorkSafeBC’s Visiting Specialist
Clinic located at 6951 Westminster Highway, Richmond, BC or any other
location designated by WorkSafeBC as a Visiting Specialist Clinic; and
(t) “WorkSafeBC Unique Fee for Service Items” means fees for Services under
this Agreement between the Doctors of BC and WorkSafeBC that refer to
WorkSafeBC Services only.
1.2 In this Agreement, the following interpretations apply:
(a) wherever the singular or neuter is used it will be construed as if the plural or
masculine or feminine, as applicable, has been used where the context
requires;
(b) headings have been included for convenience only and shall not be used in
construing any provision herein; and
3(c) the word “including” or “includes”, when following a general statement or term
does not limit the general statement or term to any specific item or matter set
forth or to similar items or matters, but permits the general statement or term
to refer also to all other items or matters that could reasonably fall within its
broadest possible scope.
1.3 Reference Documents: All Schedules, attachments, guides and manuals specifically
referenced to in this Agreement form a part of this Agreement including:
(a) Schedule A Description of Services;
(b) Schedule B WorkSafeBC Unique Fee For Service Items: Form Fees, Physician
Services Fees, and Expedited Consultation Fees by Specialists and Physicians
with Areas of Expertise;
(c) Schedule C Services Provided to WorkSafeBC on a Sessional and Expedited
Basis;
(d) Schedule D Fee Schedule for Sessional and Expedited Services;
(e) Schedule E Disability Management Education Program Subcommittee; and
(f) Schedule F Additional Commitments.
2.0 SERVICESServices: This Agreement is for the provision of medical services including
Medical Services Plan (MSP) fee items and WorkSafeBC Unique Fee for Service
Items, Expedited Physician Services and Sessional Services provided by Physicians to
WorkSafeBC Injured Workers. The Services shall be provided in compliance with all
Schedules, criteria, policies and procedures detailed in this Agreement.
2.2 Salaried Physicians: Salaried Physicians are hired by WorkSafeBC as employees. This
Agreement does not govern the relationship between WorkSafeBC and the Salaried
Physicians.
2.3 Non-Exclusive Agreements with Individual Physicians: Doctors of BC agrees and
acknowledges that WorkSafeBC may contract with individual Physicians and/or groups
of Physicians on a non-exclusive basis for WorkSafeBC Unique Fee For Service Items
outside of this Agreement that does not conflict with this Agreement, with the written
agreement from the Doctors of BC.
2.4 WCA: This Agreement is entered pursuant to the WCA and the Services provided under
this Agreement are subject to the provisions and/or policies of the WCA.
3.0 TERM OF AGREEMENT
3.1 Term: The term of this Agreement shall be for a period of thirty-six (36) months
commencing on April 1, 2019 (the “Effective Date”) and terminating on March 31,
2022.
3.2 Retroactive Terms: The Parties agree none of the terms of this Agreement shall be
retroactive unless it is expressly stated in this Agreement.
3.3 Provision Effective Date: Any provision that states an effective date as "the date of
signing of this Agreement" shall be deemed effective upon seven (7) calendar days
after the signing of the Agreement by WorkSafeBC unless otherwise stated.
3.4 Renewal: If the Parties have not concluded or renewed this Agreement by the
expiration date of this Agreement, this Agreement shall continue in effect after the
expiration date until it is replaced by a new or amended Agreement.
4.0 RELATIONSHIP BETWEEN DOCTORS OF BC AND WORKSAFEBC
44.1 Doctors of BC: WorkSafeBC recognizes the Doctors of BC as the exclusive and
authorized body to negotiate the terms of this Agreement on behalf of the Physicians
who wish to provide Services to WorkSafeBC. The Doctors of BC shall make all
reasonable efforts to ensure its members support this Agreement.
4.1.1 WorkSafeBC will not enter into separate Agreements with individual Physicians
and/or groups of Physicians that have the effect of amending any of the provisions of
this Agreement in its application to those Physicians, without the express consent of
the Doctors of BC.
4.2 Consultations: The parties agree to collaborate and engage in ongoing dialogue on
major issues of significance to the provision of the Services. The parties agree
Consultation provides opportunities to improve and implement solutions for the
delivery of Services for Injured Workers.
4.2.1 WorkSafeBC shall inform and Consult with Doctors of BC before implementing
changes that:
• May materially affect the working relationship between WorkSafeBC and the
Physicians who perform the Services for WorkSafeBC under the terms of
this Agreement for WorkSafeBC Fee For Service Items and/or Sessional
Services;
• Require affected Physicians to complete and submit new and/or modified
forms or reports to WorkSafeBC; and
• Reduce administrative requirements and conflicts for Physicians providing
WorkSafeBC Unique Fee For Service Items.
4.2.2 Where technological opportunities are identified which would benefit
WorkSafeBC but impose costs on the members of the Doctors of BC,
WorkSafeBC will not implement such opportunities without first reaching an
agreement with the Doctors of BC on responsibility for those costs. These costs
shall be restricted to those which are directly necessary to implement the
WorkSafeBC technological change.
4.2.3 Doctors of BC shall consult with WorkSafeBC before implementing changes that
shall materially affect WorkSafeBC Services or the Injured Worker.
4.3 Data and Reports: WorkSafeBC will work with the Doctors of BC to implement the
reports specified in subsections 4.3.1 and 4.3.2 below. On a quarterly and an annual
basis, WorkSafeBC will make available to Doctors of BC the following data and reports
to assist in the evaluation and administration of this Agreement free of charge:
4.3.1 When implemented, a macro-level non-identifiable aggregated data report
with the following data with respect to WorkSafeBC specific fee codes: total
number of invoices billed and paid, (to include breakdown by full and reduced
fees for delay), rejected (to include breakdown by reason for rejection),
suspended (to include breakdown by reasons for suspension), payments by
fee code and total payments overall;
4.3.2 When implemented, a macro-level level non-identifiable aggregated data
report with the following data with respect to surgical fee codes: total number
of surgeries invoiced (to include breakdown by Expedited and non-Expedited),
rejected (to include breakdown by reasons for rejection), total cost of surgeries
billed, average cost per surgery, and after-hours surcharges;
4.3.3 Other data as required for the purposes of this Agreement as agreed by
WorkSafeBC and the Doctors of BC; and
54.3.4 Reports regularly generated by WorkSafeBC for the internal management and
evaluation of this Agreement and the delivery of Services by Physicians, except
to the extent such reports may be withheld from disclosure under the Freedom
of Information and Protection of Privacy Act or are confidential WorkSafeBC
information.
4.4 Communications to Physicians: Doctors of BC shall distribute copies of this Agreement
to the Doctors of BC membership with the assistance of WorkSafeBC and shall
distribute agreed to information and updates related to this Agreement.
4.5 Additional Commitments: In the course of negotiating this Agreement, the parties
identified a number of additional commitments the parties wished to make to improve
the administration of this Agreement, processes for Physicians and allocation of
compensation. The additional commitments are set out in Schedules F.
5.0 LIAISON COMMITTEE
5.1 Intent: It is the intent of WorkSafeBC and the Doctors of BC to continue to work
collaboratively and effectively to:
5.1.1 ensure the smooth administration of this Agreement and the Services provided
under it for the benefit of the parties, Physicians and Injured Workers;
5.1.2 support Physician in providing the best possible clinical care and work disability
prevention practices to their Injured Worker patients, including through
Physician education;
5.1.3 advance disability prevention and management practices, including through a
disability management education program as contemplated in Schedule E; and
5.1.4 build the working relationship between the parties, including through
opportunities to undertake joint projects and initiatives.
5.2 Committee: To carry out the intent expressed in section 5.1, the parties will establish
a joint committee, named the “Liaison Committee” within thirty (30) calendar days of
the execution of this Agreement that will collaborate and consult on matters included
in section 5.6 and other matters referred to the Liaison Committee by agreement of
the parties. The Liaison Committee will consist of four representatives from
WorkSafeBC and four representatives from Doctors of BC. One of the WorkSafeBC
representatives will be the Chief Medical Officer or delegate and one of the Doctors of
BC representatives will be a senior member of staff.
5.3 Meetings: The Liaison Committee will have two chairs, one appointed by each party
from its representatives. The chairing of Liaison Committee meetings will be rotated
between the chairs. Subject to any public health orders, meetings chaired by the
Doctors of BC representative will be held at the Doctors of BC office and meetings
chaired by the WorkSafeBC representative will be held at the WorkSafeBC office,
unless the chairs otherwise agree. Support for the meetings will be provided by the
party chairing the meeting.
5.4 Staff Member: Doctors of BC and WorkSafeBC will each designate a staff member who
is responsible for supporting their participation in the Liaison Committee, and driving
the agenda forward by following up on discussions and actions items between
meetings.
5.5 Terms of Reference: The initial members of the Liaison Committee will meet and
establish the “Terms of Reference” for the Liaison Committee within ninety (90)
calendar days of the execution of this Agreement. The Terms of Reference established
by the Liaison Committee must include the following provisions:
65.5.1 The Liaison Committee will meet a minimum of four times a year for regular
meetings at the dates and times as agreed by the chairs, and may hold
additional meetings at the call of either chair at the date and time agreed by
the chairs;
5.5.2 The ability and process to increase the membership on the Liaison Committee
from time-to-time on an ad-hoc or permanent basis, provided there is at all
times equal membership as between WorkSafeBC and the Doctors of BC;
5.5.3 Any procedures by which the Liaison Committee will operate that are in addition
to the matters set out in subsections 5.5.1 and 5.5.2 above, including the taking
minutes and distribution of the minutes to Liaison Committee members within
30 calendar days from applicable Liaison Committee meeting;
5.5.4 Confirmation the Liaison Committee acts as the principal forum for
Consultations that may include Consultations on the addition or modification of
WorkSafeBC Unique Fee for Service Items prior to formal negotiation between
the parties;
5.5.5 Confirmation the Liaison Committee will review administrative matters affecting
the relationship between WorkSafeBC and the Doctors of BC, whether of its
own volition or in response to a referral from a party or a Physician, and will
make recommendations on those matters;
5.5.6 The ability to explore and recommend, or to establish subcommittees to explore
and recommend, projects and initiatives for the improvement of disability
management, the improvement of the case management system, the removal
of administrative impediments to Physicians and Injured Workers or any other
purpose as agreed by the parties;
5.5.7 Provision for Physicians and employees of the parties to submit ideas to the
Liaison Committee related to the matters set out in section 5.1, and a process
for response to the submitter as soon as is reasonably practicable;
5.5.8 A process for the resolution of disputes or disagreements related to this
Agreement between the parties or between WorkSafeBC and a Physician(s)
which are referred to the Liaison Committee by the joint agreement of the
parties, including issues related to practice or billing process. The process will
include the responsibility to attempt to resolve the dispute or disagreement;
and
5.5.9 A process for the resolution of disputes related to HIBC decisions on fees
including surgical assists fees which are referred to the Liaison Committee by
a Physician(s). The process will include the responsibility to attempt to resolve
the dispute or disagreement, including decisions related to pre-approvals, and
where applicable, WorkSafeBC will pay the fees including the surgical assists
fees.
5.6 Mandatory Referrals: WorkSafeBC agrees to refer the following to the Liaison
Committee for consultation and input:
5.6.1 WorkSafeBC policies and practices relevant to clinical practice, including forms
development and reporting requirements;
5.6.2 Any new requirements or initiatives for training or education for Physicians;
5.6.3 Opportunities to improve Physician understanding of WorkSafeBC forms, fees
and processes;
75.6.4 Occupational health care issues;
5.6.5 Rehabilitation initiatives with a specific view to obtaining the expertise of
Doctors of BC; and
5.6.6 Any new Physician education initiatives, prior to implementation.
5.7 Projects and Initiatives: In the event the Liaison Committee or a subcommittee
appointed by it recommends a project or initiative be undertaken and WorkSafeBC
agrees with the recommendation, the Liaison Committee will work with WorkSafeBC
to develop business cases, project plans, funding models or other materials required
by WorkSafeBC to initiate the project or initiative. Where implementation of the project
or initiative requires any amendment to this Agreement, including but not limited to a
new fee-for-service item, WorkSafeBC will negotiate that amendment with Doctors of
BC. WorkSafeBC has no obligation to accept any recommendation and may decline a
recommendation for any reason.
5.8 Pilots: The Liaison Committee may recommend or WorkSafeBC may propose that a
pilot be conducted with respect to a project or initiative. WorkSafeBC has the right, in
its discretion, to determine whether to enter into the pilot, the scope and duration of
the pilot, the cost it will expend on the pilot, and the measurements and reporting with
respect to the pilot. If after implementation of a pilot, WorkSafeBC is not satisfied with
the results, the parties agree WorkSafeBC is under no obligation to move to
subsequent phases of the pilot or design further pilot testing.
5.9 Pilot Costs: WorkSafeBC may pay for development of any business cases where
reasonable and will pay Physicians when participating in the development of pilots and
acting in the capacity of a subject matter expert either on a Sessional Services basis
where appropriate or on a pilot fee-for-service basis, as agreed by the parties.
5.10 Participation Costs: Each party will be responsible for costs of their participation on
the Liaison Committee. WorkSafeBC agrees to pay any reasonable administrative costs
related to the meetings.
5.11 Annual Reports: Each party’s chair will submit an annual report to the other party’s
chair no later than 90 (ninety) calendar days after the end of each calendar year
evaluating the effectiveness of the Liaison Committee and of any projects and
initiatives sponsored by the Liaison Committee, including whether the project or
initiative met its stated objective and any issues encountered that could not be solved
by the Liaison Committee. WorkSafeBC’s chair will provide a copy of the Doctors of BC
annual report to the WorkSafeBC executive. Doctors of BC will provide a copy of
WorkSafeBC’s annual report to the Doctors of BC Board of Directors.
5.12 Agreement Prevails: The Liaison Committee does not have the right to take any action
or make any decision that conflicts with any provision in this Agreement, and may by
the agreement of the parties be dissolved.
86.0 ELECTRONIC PAYMENT SYSTEM
6.1 Current: The Physicians shall use the electronic payment system for invoicing as
specified by WorkSafeBC. The current system available for electronic submission of
invoices is the Medical Services Plan (MSP) Teleplan system, unless the Injured Worker
does not possess a valid Personal Health Number (PHN).
WorkSafeBC may exempt specific Physicians from this requirement where compliance
is not possible. WorkSafeBC shall be responsible for the administration and transaction
costs for Teleplan. Teleplan administration and transaction fees shall be paid by
WorkSafeBC.
7.0 INVOICING
7.1 Authorized Services: The Physicians shall only submit invoices to WorkSafeBC for
authorized Services provided to an Injured Worker as described and in compliance
with the B.C. Medical Services Plan Fee Schedule and Schedules A, B, C, and D of this
Agreement. All exceptions shall be referred to the Liaison Committee.
7.2 Charges: No additional charges shall be invoiced to or payable by WorkSafeBC.
7.3 Fee Codes: WorkSafeBC has assigned fee codes to the fee descriptions set out in Fee
Schedules. The Physicians shall only submit invoices that reference the appropriate
fee code as described in the fee Schedules and WorkSafeBC Physician Reference
Services Guide.
7.4 Invoice Submission: The Physicians shall submit invoices within ninety (90) calendar
days of the completion of the Services in accordance with the fee Schedules and
WorkSafeBC Physician Reference Services Guide. Invoices received after ninety (90)
calendar days from the completion of the Services may not be paid by WorkSafeBC,
unless it is submitted due to reimbursing the Injured Worker for fees paid for an
accepted claim.
7.5 Individual Manual (Paper) Invoices for Each Injured Worker: Where the Physician
submits a manual invoice, the Physician shall only reference the Services provided to
one (1) Injured Worker in an invoice. Where a Physician is providing Services for
multiple Injured Workers simultaneously, the Physician shall issue a separate invoice
for Services rendered for each Injured Worker.
7.6 Electronic and Fax Submissions: Physicians shall submit invoices and forms for Form
8 and 11 only through MSP Teleplan (Electronically) or by fax transmission.
8.0 PAYMENT
8.1 Authorized Services: WorkSafeBC shall compensate the Physicians in accordance with
the B.C. Medical Services Plan Fee Schedule and Schedules A, B, C, and D of this
Agreement for providing Services to Injured Workers and only if the Services are
authorized by WorkSafeBC and the Physician has provided the Services in compliance
with the terms and conditions of this Agreement, or where the Physician has entered
into an agreement with WorkSafeBC directly for personal Services or Sessional
Services, in compliance with that agreement.
8.2 Fee Schedules: WorkSafeBC shall pay for all Physician Services provided to Injured
Workers entitled to benefits under the WCA in accordance with the following:
8.2.1 The 2019 Physician Master Agreement as negotiated between the Doctors of
BC, the Government and the Medical Services Commission.
98.2.2 A fee increase as follows to be applied to all fee items as per Schedules B, C
and D; with the exception of out-of-office surcharge fee codes (19405, 19406,
19407, 19410, 19411, 19412):
• Effective April 1, 2020: 2.3%
• Effective April 1, 2021: 2.3%.
8.2.3 The B.C. Medical Services Plan Fee Schedule plus a premium of ten percent
(10%) if the Physician invoices WorkSafeBC Electronically through MSP
Teleplan.
8.2.4 Those Physicians who do not submit through MSP Teleplan will receive a
reduced premium of three percent (3%).
8.3 B.C. Medical Services Plan Fee Schedule: The Parties agree that if the Medical Services
Commission prorates the fee schedules contained in the B.C. Medical Services Plan Fee
Schedule, it shall not have an effect upon this Agreement.
8.4 WorkSafeBC Unique Fee for Service Items: WorkSafeBC shall compensate Physicians
as set out in Schedules A, B, C, and D and Physicians Reference Guide.
“Unique Fee for Service Items” are fees that are exclusive to WorkSafeBC
requirements. WorkSafeBC agrees to Consult and discuss with Doctors of BC the intent
to delete any Unique Fee for Service Item. WorkSafeBC shall provide sixty (60)
calendar days notice following the consultation process with Doctors of BC and prior
to the deletion of a Unique Fee for Service Item.
Following Consultation with Doctors of BC, WorkSafeBC reserves the right and at any
time, to delete any of the Unique Fee for Service Items. WorkSafeBC will negotiate
with the Doctors of BC for the addition or modification of Unique Fee for Service Items,
either through formal negotiations or through the process described in section 5.5.4.
8.5 Sessional Services: WorkSafeBC shall compensate Physicians acting as Medical
Advisors, and Physicians performing Expedited Services, on a sessional basis as set
out in Schedules C and D.
8.6 Subsequent Acceptance of a Claim by WorkSafeBC: Where a claim is initially rejected
and the initial treatment is subsequently accepted by WorkSafeBC, the submission of
Form 8 and other required information or chart notes shall commence from the date
the request is communicated by a Board Officer.
8.7 Office Visit and Form Fee: WorkSafeBC will pay the full cost of the office visit, if the
injury is compensable and the injury is the primary reason for the office visit and where
applicable, a form fee. WorkSafeBC shall not pay for any other injuries and complaints.
The Physician of first contact or attending Physician must complete a Form 8 where
the Physician suspects the Injured Worker may be disabled beyond the day of injury
or if the claim is for a hernia, back condition, shoulder or knee strain/sprain, mental
disorder, or occupational disease.
8.8 Interest: WorkSafeBC shall reimburse interest on outstanding accounts per the process
employed by MSP, except where specifically exempted as set out in section 6.1.
8.9 Interest Rate: Interest rate shall be that used by MSP.
8.10 Interest Retroactive: The interest on outstanding accounts will be retroactive to the
date of the transmission of the invoice to WorkSafeBC and compounding will occur
monthly. The payment of interest will be made at the time the account is processed.
108.11 Rural Retention Program Premium: WorkSafeBC shall compensate the Rural Retention
Program Premium equivalency to the Medical Services Plan for Physicians residing in
qualified communities. Locum Physicians shall submit invoices with the residing
Physician’s payment number. Where this is not practicable, the locum Physician may
receive the Rural Retention Program Premium by submitting their own payment
number if prior notification is given to WorkSafeBC. The Rural Retention Program
premium is not payable to sessionals providing Medical Advisor services listed in
Schedule D.
8.12 Electronic and Fax Submissions: WorkSafeBC shall only compensate Physicians for
invoices and forms for Form 8 and 11 submitted Electronically through MSP Teleplan
or by fax transmission. WorkSafeBC shall not compensate Physicians that submit
invoices or forms for Form 8 and 11 by mail.
8.13 Invoice Returns: WorkSafeBC shall return to the Physician invoices containing
discrepancies or errors, noting areas for correction. If the defect is minor, WorkSafeBC
may correct the invoice. WorkSafeBC shall not pay the Physician until an invoice
complies with the terms of this Agreement and is received by WorkSafeBC or the
invoice has been corrected by WorkSafeBC.
9.0 PHYSICIAN EXPECTATIONS
9.1 The Doctors of BC agrees to advise Physicians of the following expectations
WorkSafeBC has of Physicians providing the Services:
9.1.1 Physicians must be a current member in good standing with the College of
Physicians and Surgeons of British Columbia;
9.1.2 WorkSafeBC may undertake a review to confirm the professional credentials of
the Physician at any time during the Term of this Agreement;
9.1.3 Physicians will immediately notify WorkSafeBC of any change in status or any
restrictions on their practice imposed by the College of Physicians and Surgeons
which affects their ability to provide the Services. If WorkSafeBC determines
that any changes in status or restrictions imposed by the College of Physicians
and Surgeons affect a Physician’s ability to provide the Services that have been
referred by WorkSafeBC, WorkSafeBC may immediately suspend or terminate
those Services;
9.1.4 Physicians will not use the name of any Injured Worker for any advertising,
solicitation, in any mailing list or publication, written or verbal, without prior
written consent from the Injured Worker. If WorkSafeBC, in its sole discretion,
determines that any advertising, publication or solicitation by the Physician is
inappropriate or in any way causes harm to WorkSafeBC or its reputation
WorkSafeBC may in writing direct the Physician to cease using any reference
to WorkSafeBC in its advertising, except where previously authorized by
WorkSafeBC;
9.1.5 The Physicians, his and her employees are required, as soon as possible and
no later than twenty-four (24) hours from being made aware of the threat,
report to WorkSafeBC any threats, whether perceived or actual, made by
Injured Workers. Threats include, but are not limited to: physical threats and
suicide threats. Reports shall be made to the WorkSafeBC Corporate Security
Department at (604) 279-7578. If there is imminent danger to anyone, the
Physician shall contact the local policing authorities without delay;
9.1.6 Physicians shall report, verbally and in writing, to the WorkSafeBC Program
Manager of Health Care Services, any physical or psychological trauma
11sustained by the Injured Workers while attending the Physician’s facility. The
incident or trauma must be reported within twenty-four (24) hours, or as soon
as reasonably possible, of the Physician becoming aware of it having occurred;
9.1.7 Physicians shall not, in any manner whatsoever, commit WorkSafeBC to the
payment of any money to any person, firm or corporation. WorkSafeBC is not
responsible for any deductions or remittances for the Physician; and
9.1.8 In addition to the Professional Standards and Guidelines for Conflict of Interest
established by the College of Physician and Surgeons, the Physician shall ensure
that the Services are provided to WorkSafeBC without any conflict of interest.
If the Physician recognizes or perceives a conflict of interest, the Physician shall
immediately provide written notice to WorkSafeBC.
10.0 RIGHT OF SET OFF
10.1 If, under this Agreement, or any document delivered under this Agreement,
WorkSafeBC becomes obligated or liable to pay any money to the Physician, that sum
may at the election of WorkSafeBC and without limiting or waiving any right or remedy
against the Physician under this Agreement, hereunder be set off against and apply
that sum applied to any amounts owing by the Physician to WorkSafeBC under this
Agreement, including but not limited to prior over billing, which are due and owing by
the Physician to WorkSafeBC until that amount has been completely set off.
11.0 DISPUTE RESOLUTION BETWEEN THE PHYSICIAN AND WORKSAFEBC
11.1 The Physician and the Program Manager, Health Care Services or designate shall
attempt to resolve individual disputes arising solely in reference to invoicing and
administrative issues pursuant to this Agreement.
11.2 If the dispute is not resolved between the Physician and the Program Manager of
Health Care Services or designate, then the issue may be referred to the Physician and
External Affairs Department of the Doctors of BC. The Physician and External Affairs
Department representative and WorkSafeBC shall attempt a resolution of the dispute.
11.3 If the dispute is not resolved between the Physicians External Affairs Department
representative and WorkSafeBC, then the issue may be referred to the Liaison
Committee for recommendation.
11.4 If the dispute is not resolved by the Liaison Committee, then within fourteen (14)
calendar days the issue may be referred to mediation by mutual agreement of both
Parties. A neutral mediator shall be jointly selected by the WorkSafeBC and the Doctors
of BC.
11.5 If the dispute has not been referred to mediation or cannot be settled within forty-five
(45) calendar days after the mediator has been appointed, or within such other period
as agreed to by WorkSafeBC and the Doctors of BC in writing, the dispute may be
referred by either Party to expedited arbitration administered pursuant to the
Arbitration Act.
11.6 WorkSafeBC and the Doctors of BC shall be responsible for their own costs and agree
to equally share the costs of the mediator and/or arbitrator.
12.0 DISPUTE RESOLUTION BETWEEN DOCTORS OF BC AND WORKSAFEBC
12.1 At the written request of either Party, any dispute arising over the interpretation,
application or alleged breach of any clause(s) of this Agreement shall be immediately
addressed by the signatories to this Agreement.
1212.2 Any dispute regarding the application, interpretation or alleged breach of this
Agreement will be referred to the Liaison Committee by joint agreement of the parties
or a separate committee comprised of an equal number of representatives from the
Doctors of BC and WorkSafeBC where WorkSafeBC’s representatives will include at
least one Senior Director or Vice President. Either committee shall have the power to
render binding decisions on the basis of a majority and have the authority to expand
this agreement where necessary.
12.3 Any dispute regarding the interpretation, application, or alleged breach of this
Agreement which is not resolved pursuant to section 12.2, will be resolved pursuant
to the Arbitration Act.
12.4 Should the Parties be unable to agree on the selection of an arbitrator within seven
(7) calendar days after notice is served by either party seeking the appointment of an
Arbitrator, the Supreme Court of British Columbia will be asked to appoint the
Arbitrator under the provisions of the Arbitration Act.
12.5 WorkSafeBC and the Doctors of BC will each bear their own costs and share equally
the fees and expenses of the Arbitrator.
13.0 NON-WAIVER
13.1 No provision of this Agreement and no breach by either party of any provision will be
deemed to have been waived by the other party unless such waiver is in writing and
signed by the other party.
13.2 The written waiver by either party of any breach by the other party of any provision
of this Agreement is not to be deemed a waiver of any subsequent breach by that
party of the same or any other provision of this Agreement.
13.3 Payment by WorkSafeBC of any invoice to the Physician for Services rendered by the
Physician shall not be deemed to be a waiver of any breach of the Physician’s
obligations arising under this Agreement.
14.0 VARIATION OF AGREEMENT
14.1 Except as where otherwise provided for in this Agreement, this Agreement will not be
varied unless such variation is in writing and is signed by the authorized signatories of
WorkSafeBC and Doctors of BC.
14.2 At any time during the term of this Agreement or any subsequent renewals
WorkSafeBC may amend the Physicians Reference Guide without the consent of the
Doctors of BC or Physician.
WorkSafeBC shall ensure the Physicians Reference Guide and any subsequent
amendments are available for Physicians and in an electronic form. Any such
amendment becomes effective on the first date of the following month the amendment
is posted on www.WorkSafeBC.com.
15.0 GENERAL CONTRACT NOTICES
15.1 Any notice, report or any or all documents that either Party may be required to give
or deliver to the other must be delivered in the following manner and will be deemed
delivered to and received by the address, if:
• Delivered personally, on the date of delivery; or
• Fax, on the date of the fax confirmation; or
13• Registered mail, if mailed within British Columbia, within eight (8) calendar days
after mailing and if mailed to or outside British Columbia, within fourteen (14)
calendar days after mailing; or
• Regular mail, when received by the addressee.
If a dispute arises over whether or not a document has been delivered, the party
claiming delivery must provide proof of delivery to, if WorkSafeBC:
Manager, Purchasing Services
6951 Westminster Highway
Richmond, BC, V7C 1C6
Fax #: (604) 276-3260
and if to Doctors of BC:
Executive Director of Negotiations & Chief Negotiator
115 – 1665 West Broadway
Vancouver, BC V6J 5A4
Fax #: (604) 638-2921
15.2 Either party may, from time to time, give to the other party written notice of any
change of address or service location and after giving notice the address will, for
purposes of the preceding paragraph, be deemed to be the address of the party giving
such notice.
16.0 FORCE MAJEURE
16.1 Neither party will be liable for any failure or delay to perform that party's obligations
resulting from any cause beyond that party's reasonable control, including but not
limited to wars, acts of terrorism, riot, fires, strikes, work stoppages or slowdowns,
floods, hurricanes, tsunamis, or other extreme climatic events, pandemics, or delays
caused by material shortages. If an event of force majeure occurs, the party who fails
to perform its obligations shall notify the other Party and use commercially reasonable
efforts to rectify the event of force majeure and resume its obligations with the least
possible delay.
17.0 MISCELLANEOUS
17.1 Laws: This Agreement shall be governed by and construed in accordance with the laws
of the Province of British Columbia, and each of the parties by their execution of this
Agreement irrevocably attorns to the exclusive jurisdiction of the courts of the Province
of British Columbia.
17.2 Severability: If any provision of this Agreement is for any reason held to be
unenforceable or invalid, that provision shall be considered separate and severable
from this Agreement, and the other provisions of this Agreement shall remain in force
and continue to be binding upon the Parties as though the unenforceable or invalid
provision had never been included in this Agreement.
18.0 ENTIRE AGREEMENT
18.1 Entire Agreement: This Agreement includes the Schedules attached to it constitute the
entire Agreement between WorkSafeBC and the Doctors of BC and supersedes all
previous communications, representations, understandings, and agreements whether
verbal or written between the parties with respect to the subject matter of this
Agreement.
14IN WITNESS WHEREOF, ASSOCIATION OF THE DOCTORS OF BC and the WORKERS'
COMPENSATION BOARD, have executed this Agreement as of the Effective Date.
Signed for and on behalf of
ASSOCIATION OF THE DOCTORS OF BC
Authorized Signatory
Dr. Mathew Chow
Print Name of Signatory
President
Title:
Date:______February 1st, 2021___________________
Signed for and on behalf of Signed for and on behalf of
WORKERS' COMPENSATION BOARD WORKERS' COMPENSATION BOARD
Authorized Signatory Authorized Signatory
Tara Mudray Andrew Montgomerie,
Senior Manager Purchasing Senior Director Health Care Services
February 1, 2021
Date:___________________________ Date:_January 27, 2021___________
15SCHEDULE A
DESCRIPTION OF SERVICES
1.0 INTRODUCTION
1.1 Almost all workers in BC are covered under the WCA. WorkSafeBC provides coverage
for the treatment of injuries and diseases that it has accepted as work caused. As
such, medical Services provided to Injured Workers covered and accepted under the
WCA are not insured by the Medical Services Plan.
1.2 Working with Physicians and employers in the community, WorkSafeBC’s goal is to
facilitate a safe, timely, and durable return to work for Injured Workers. Prolonged
absences from the workplace often result in de-conditioning, a reduced likelihood of
recovery, increased pressure on family and personal relationships and a loss of self-
esteem, as well as costly uses of health care and social services.
1.3 The issue of causation is important to WorkSafeBC as the WCA refers to personal
injury, disease or death “arising out of and in the course of employment”. Employment
factors need not be the sole cause, or even the predominant cause, in order for the
injury or disease to be accepted. In order for the injury or occupational disease to be
compensable, the employment has to be of ‘causative significance’, which means it
has to be more than a trivial or insignificant cause of the injury or disease.
1.4 To be considered work-related, there must be a fifty-percent (50%) or greater
probability that a condition arose out of work. It is not sufficient that it is “possible”
that the condition arose out of work.
1.5 The Doctors of BC recognizes the Physicians’ role in rehabilitating Injured Workers and
assisting WorkSafeBC in returning them to work. To this end, where reasonable,
Physicians will advise Injured Workers that a safe and timely return to work may
hasten their recovery. The concept of “hurt vs. harm” is important in occupational
medicine.
1.6 It is not possible to provide a specific diagnosis in every case. It may, however, be
possible to exclude serious or progressive conditions that may be worsened by work.
2.0 PHYSICIANS ROLE IN FACILITATING A RETURN TO WORK
2.1 The Doctors of BC will encourage Physicians to assist Injured Workers in receiving the
benefits they are entitled to under the WCA.
2.2 Physicians will provide care to Injured Workers under this Agreement and will support
the principles of disability management with employers and Injured Workers to
optimize recovery and facilitate a safe early return to work.
2.3 Physicians will provide appropriate support and encouragement to Injured Workers in
order to facilitate their participation in appropriate rehabilitation programs, provided
by employers or by WorkSafeBC, directed at early recovery and return to work.
2.4 Physicians will encourage Injured Workers, with assistance of the Injured Workers'
employers, to recognize the evidence based principle that early return to their work or
a modified version of their work (therapeutic return to work) offers the most effective
route to recovery from many injuries, in particular soft tissue injuries.
2.5 Physicians will endeavor to communicate effectively through established reporting
mechanisms, and contact with WorkSafeBC staff and rehabilitation providers, to
facilitate exchange of claim related information which is directed at achieving early
return to work and providing necessary benefits to Injured Workers.
16SCHEDULE A
DESCRIPTION OF SERVICES
2.6 Physicians will, if making recommendations for job modification, take into account any
detailed fitness assessment and job evaluation information made available to them
and recognize that, in order of effectiveness:
1) return to original work with original employer,
2) return to modified work with original employer,
3) return to similar work with another employer,
4) return to modified work within the same industry,
are all options which should be beneficially explored before formal retraining to a new
occupation is considered.
2.7 In most cases it is advisable for Physicians to limit recommendations they make with
respect to suitability to return to other than the original employment, to factual
statements about any physical limitations present or recommended restrictions of
specific activities which may be necessary pending full recovery.
2.8 The return to work consultation (fee code 19950) is described in Schedule A section
8.0.
3.0 OCCUPATIONAL HEALTH EDUCATION
3.1 WorkSafeBC undertakes to liaise with the Doctors of BC regarding occupational health
care issues.
3.2 Rehabilitation initiatives will be discussed with the Doctors of BC during development,
providing the Doctors of BC with an opportunity to contribute its expertise.
3.3 Advances in occupational medicine and changes to WorkSafeBC policies and
procedures with respect to occupational diseases will be communicated to the Doctors
of BC in a timely manner.
3.4 WorkSafeBC will raise the profile of occupational medicine and ensure that it is
represented in Continuing Medical Education within the Province.
4.0 DOCUMENTATION REQUIRED TO INITIATE AND MANAGE A CLAIM
4.1 A Board Officer determines entitlement and acceptance of a claim. Entitlement
decisions are reliant upon the prompt receipt of information in supporting
documentation from:
Employer/Worker Information
Separate forms are completed by the employer and worker.
• Form 6 - Workers’ Application for Compensation
• Form 6 may be completed and signed by the worker as a hardcopy form,
completed Electronically through worksafebc.com or over the telephone
through Teleclaim. If WorkSafeBC does not receive the Form 6, a claim may
be suspended and may not be paid.
• Form 7 - Employer Report
Physician Information
• Form 8 – Physician Report (treating Physician) – first report of injury
• Form 11 – Progress Report
17SCHEDULE A
DESCRIPTION OF SERVICES
5.0 ELECTRONIC SERVICE REQUIREMENTS
5.1 Payment for a Form 8 will only be made for the first Form 8 received by WorkSafeBC
submitted by any Physician, and if a second Form 8 is subsequently submitted
Electronically by the Injured Worker’s regular Physician and it is received by
WorkSafeBC within ten (10) business days from the date on which the first Form 8
was received by WorkSafeBC, it will be paid at the Form 8 rate, rather than the Form
11 rate.
5.2 In order to indicate that the Physician is the Injured Worker’s regular Physician, and
to be paid the Form 8 rate, the Physician must answer “yes” to the question on the
Form 8 “Are you the injured worker’s regular practitioner?”
5.3 A Physician may only submit one Form 8 per claim. Any subsequent Form 8 will be
paid at a Form 11 rate.
5.4 Any submitted Forms 8 and 11 that are missing mandatory field(s) or are illegible will
be rejected without any cost to WorkSafeBC.
5.5 Fees will be reimbursed based on submission Electronically or fax transmission and
timeliness of receipt from date of service as described in Schedule B.
6.0 MEDICAL TREATMENT - FORMS, REPORTS AND SERVICES
6.1 Current service and submission requirements for Forms 8 and 11 are described in
Schedule A - section 5.0:
Form 8 - First Report of Injury
6.1.1 The Physician of first contact or the Injured Worker’s regular Physician must
complete a Form 8 where the Physician suspects the Injured Worker may be
disabled beyond the day of injury or if the claim is for a hernia, back condition,
shoulder or knee strain/sprain, occupational disease, or mental disorder.
6.1.2 The Parties agree that if WorkSafeBC requests a First Report of Injury (Form
8), when a Form 8 was not initially required, WorkSafeBC will pay fee code
19927. The time limit for the submission of this form and/or medical records is
ten (10) business days from the date the request is faxed or telephoned by
WorkSafeBC.
6.1.3 WorkSafeBC will reimburse the Physician for a Form 8 and an office visit for the
first visit where the Physician suspects the Injured Worker may be disabled
beyond the day of injury or if the claim is for a hernia, back condition, shoulder
or knee strain/sprain, occupational disease, or mental disorder.
6.1.4 Form 8 shall not be billed by a Specialist submitting an Expedited consultation.
6.1.5 There will be no payment for forms received after the time limits described in
this Agreement in Schedule B.
Form 11 - Progress Report
6.1.6 Follow-up examination visits shall be conducted by the attending Physician as
medically necessary, as a result of Injured Worker requirement or at the
request of a Board Officer.
6.1.7 Form 11 will only be supplied for a change of medical condition or as an
accompaniment to fee codes 19509, 19510, 19511 and 19950. A Form 11
where there is no change in the Injured Worker’s medical condition, treatment
18SCHEDULE A
DESCRIPTION OF SERVICES
plan, or return to work status is not payable unless an interval of at least four
(4) weeks has passed since the Physician last billed a Form 11.
6.1.8 Follow-up examination visits will be paid regardless of whether a Form 11 has
been submitted.
6.1.9 There will be no payment for forms received after the time limits described in
this Agreement as indicated in Schedule B.
6.1.10 The Parties agree that if WorkSafeBC requests a Form 11, when a Form 11 was
not initially required, WorkSafeBC will pay fee code 19559. The time limit for
the submission of this form is ten (10) business days from the date the request
is faxed or telephoned by WorkSafeBC.
7.0 EXPEDITED COMPREHENSIVE CONSULTATION
7.1 Referrals for Initial and Repeat Expedited Comprehensive Consultations can be made
to a Specialist Physician by WorkSafeBC or a referring Physician.
7.2 Specialist Physicians and Physicians With Areas of Expertise are entitled to the
Expedited Comprehensive Consultation fee if the following criteria are met:
7.2.1 Reporting Timeliness:
7.2.1.1 The Initial Expedited Comprehensive Consultation (includes trauma
and emergency cases) report must be received by WorkSafeBC within
fifteen (15) business days from the referral.
7.2.1.2 Referrals other than the Initial Expedited Comprehensive
Consultation: The report must be received within fifteen (15) business
days of the referral.
7.2.1.3 For any other consultations: The report must be received within five
(5) business days of the consultations.
7.2.1.4 Where following a consultation the Physician concludes the Injured
Worker is fit to return to work, this information must be received
within three (3) business days of the consultation.
7.3 Initial Expedited Comprehensive Consultation:
7.3.1 The Physician is entitled to the Initial Expedited Comprehensive Consultation
fee for the first consultation on each claim and a new Initial Expedited
Comprehensive Consultation fee when both of the following conditions occur:
7.3.1.1 more than six (6) months lapsed since the Physician last saw the
Injured Worker; and
7.3.1.2 the consultation is as a result of a new referral.
7.3.2 Where the consultation occurs as a result of an emergency (e.g. trauma), the
Specialist is entitled to receive the Initial Expedited Comprehensive
Consultation fee.
7.4 Repeat Expedited Comprehensive Consultation: The Physician is entitled to the Repeat
Expedited Comprehensive Consultation fee for one (1) repeat consultation when the
repeat consultation occurs within twelve (12) weeks of the Initial Expedited
Comprehensive Consultation for which fee code 19911 was billed. Any other repeat
consultation is not entitled to Expedited fees.
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